Basic Information
| Provider Information | |||||||||
| NPI: | 1467432815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CWIK | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9059 W. LAKE PLEASANT PKWY | ||||||||
| Address2: | STE E-540 | ||||||||
| City: | PEORLA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233223380 | ||||||||
| FaxNumber: | 6233224399 | ||||||||
| Practice Location | |||||||||
| Address1: | 9305 W THOMAS RD | ||||||||
| Address2: | STE 125 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850373328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233883216 | ||||||||
| FaxNumber: | 6233884902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 37360 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4434626 | 05 | MI | MEDICAID | 258231 | 05 | AZ | MEDICAID |